Briggs: For infants, babies, and non-verbal toddlers, parents may see increased irritability, startle responses, separation anxiety, crying, sleep disturbance, changes in feeding habits, and overall regression (for example, a child who was previously toilet trained may begin soiling his diapers). It is also important to note that while babies cannot verbalize their memories of traumatic events, we often see the remnants of the incident in their play and conversations as toddlers and older children.
For verbal toddlers and preschool age children, all of the above concerns are relevant. In addition, these children may repeatedly ask about the incident, either directly or in a more "round about" fashion (for example, asking about a pet goldfish, or swimming at the pool). Parents may see representations of the incident in children's play, as they may draw fish, whales, oceans, swimming pools, bodies, etc. Children may suddenly refuse to separate from parents in order to go to school, may have difficulty concentrating while in school, may tantrum, may show decreased exploration and play, and may become curious and fearful about death and separation in general.
Question: To what extent might witnessing this event be a source of long-term psychological effects for a child, and what might those effects be (i.e. a fear of water or a fear of animals)?
Briggs: We know that young children do experience PTSD. The diagnosis of PTSD requires that one or more symptoms from each of the following categories be present for at least a month and that symptom or symptoms must seriously interfere with leading a normal life:
Re-experiencing the traumatic event:
Post-traumatic play: play that represents a reenactment of some aspects of trauma
Traumatic event outside play, such as drawing pictures related to the event.
Distress at exposure to reminders of the trauma.
Episodes with objective features of a flashback or dissociation: a child makes dolls fight after hearing a siren because it reminds the child of the ambulance that arrived after the argument between the child's parents.
Numbing of responsiveness:
Night terrors: child starts from sleep with a panicky scream and shows some signs such as rapid breathing, racing pulse, and sweating.
Difficulty going to sleep.
Exaggerated startle response.
Symptoms not present before the traumatic event:
Aggression toward peers, adults or animals.
Fear of toileting alone.
Fear of the dark.
Other new fears.
Pessimism or self-defeating behavior.
Sexual and aggressive behaviors inappropriate for a child's age.
Other new symptoms.
(Source: the DC:0-3R, the diagnostic classification system for infants and toddlers,published by Zero to Three. Full title: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised)